Letters of substance use.6 Knowledge of these similarities can help guide the physician. Studies examining these associations within states, such as Colorado, that lack age restrictions for indoor tanning may foster regulation of this carcinogenic activity. This study analyzes results from a survey of Colorado high school students to examine state-level associations between substance use and indoor tanning.
RESEARCH LETTER
Associations Between Indoor Tanning and Substance Use Among Colorado High School Students The World Health Organization classifies UV radiation as a group 1 carcinogen and deems the use of tanning devices that emit UV radiation a risk factor for melanoma, basal cell carcinoma, and squamous cell carcinoma.1 Nonetheless, about 1 in 5 adolescents have used a UV tanning bed in their lifetime.2 A growing national body of evidence links indoor tanning with other risky health-related behavior among adolescents.3,4 Motivation for indoor tanning is multifactorial, including physiological and psychological factors. For example, indoor tanning and use of steroids may both stem from the motivation to enhance one’s appearance.5 Data also implicate addictive physiological pathways in indoor tanning that may be similar to those
Methods | The Healthy Kids Colorado Survey collected selfreported health data from Colorado public schools. The University of Colorado Denver Institutional Review Board approved this study. More than 220 schools and 40 000 students in 21 regions participated in the 2013 Healthy Kids Colorado Survey that was administered from August through December 2013. Questionnaires including an item on the frequency of indoor tanning reached 12 671 high school students. Items
Table 1. Univariate Analysis: Weighted Percentage of Tanning and Nontanning Students Reporting Substance Usea,b Tanning at Least Once in Past 12 Months, % (No./Total No.)
Characteristic
No Tanning in Past 12 Months, % (No./Total No.)
Odds Ratio (95% CI)
Sex Female
64.5 (551/842)
48.3 (5613/11 302)
Male
33.8 (277/842)
51.1 (5609/11 302)
c
Unknown
2.0 (1.6-2.5)
0.6 (80/11 302)
Age, y ≤12
c
c
13
c
c
14
7.0 (66/837)
17.8 (1993/11 286)
15
19.8 (165/837)
26.2 (3059/11 286)
16
22.2 (200/837)
24.8 (2865/11 286)
17
31.6 (242/837)
23.1 (2471/11 286)
≥18
16.6 (132/837)
7.7 (843/11 286)
a
Unadjusted logistic regression of weighted percentage of students reporting use of each substance in each of the 2 populations (tanning and nontanning). Percent does not equal ratio. Percent is weighted to account for the probability of student selection and to reduce bias by adjusting for differing patterns of nonresponse. Adjustments allow for the generalization of findings to the public high school student population of Colorado.
Any lifetime use Cocaine
23.1 (200/834)
4.0 (500/11 235)
7.2 (5.5-9.3)
Inhalantsd
26.2 (217/836)
5.4 (664/11 221)
6.2 (4.9-7.9)
Heroin
17.7 (161/833)
1.4 (159/11 193)
14.7 (10.6-20.3)
Methamphetamines
18.2 (167/831)
1.8 (216/11 170)
12.0 (8.8-16.3)
b
P < .001 for all characteristics.
Ecstasy
27.8 (234/835)
5.0 (631/11 230)
7.4 (5.8-9.3)
c
Prescription drugse
38.6 (312/837)
11.5 (1400/11 226)
4.9 (3.9-6.0)
Steroidsf
20.8 (177/836)
1.5 (165/11 225)
16.8 (12.2-23.0)
Suppressed owing to raw (unweighted) data being less than 50.
d
Marijuana
66.2 (522/798)
35.3 (4067/11 115)
3.6 (2.9-4.4)
Any one of the above
70.1 (543/780)
39.3 (4464/10 958)
3.6 (3.0-4.5)
Sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high.
e
Prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, Xanax) used without a prescription.
f
Steroid pills or shots without a prescription.
g
Binge drinking defined as 5 or more drinks of alcohol in a row, within a couple of hours.
Use within last 30 d Marijuana at least once
44.5 (368/802)
18.1 (2180/11 141)
3.6 (3.0-4.4)
Cigarettes at least once
28.5 (258/798)
9.6 (1181/11 179)
3.8 (3.0-4.7)
Alcoholic drink at least once
63.1 (473/745)
29.1 (3312/10 883)
4.2 (3.4-5.1)
Marijuana, alcohol, or cigarette at least once
68.34 (482/698)
35.2 (3946/10 701)
4.0 (3.2-4.9)
Binge drinking at least onceg
40.98 (333/764)
15.3 (1816/10 913)
3.9 (3.1-4.7)
9.6 (101/842)
1.5 (233/11 302)
6.9 (4.9-9.7)
Daily cigarettes
jamadermatology.com
(Reprinted) JAMA Dermatology Published online January 20, 2016
Copyright 2016 American Medical Association. All rights reserved.
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E1
Letters
Table 2. Multivariate Analysis: Adjusted Logistic Regression Analysis Stratified by Sexa All, Odds Ratio (95% CI)
P Value
Females, Odds Ratio (95% CI)
P Value
Heroin
2.1 (1.2-3.5)
.01
b
b
Prescription
1.7 (1.3-2.3)
3.7 (1.7-7.8)
RESEARCH LETTER
Associations Between Indoor Tanning and Substance Use Among Colorado High School Students The World Health Organization classifies UV radiation as a group 1 carcinogen and deems the use of tanning devices that emit UV radiation a risk factor for melanoma, basal cell carcinoma, and squamous cell carcinoma.1 Nonetheless, about 1 in 5 adolescents have used a UV tanning bed in their lifetime.2 A growing national body of evidence links indoor tanning with other risky health-related behavior among adolescents.3,4 Motivation for indoor tanning is multifactorial, including physiological and psychological factors. For example, indoor tanning and use of steroids may both stem from the motivation to enhance one’s appearance.5 Data also implicate addictive physiological pathways in indoor tanning that may be similar to those
Methods | The Healthy Kids Colorado Survey collected selfreported health data from Colorado public schools. The University of Colorado Denver Institutional Review Board approved this study. More than 220 schools and 40 000 students in 21 regions participated in the 2013 Healthy Kids Colorado Survey that was administered from August through December 2013. Questionnaires including an item on the frequency of indoor tanning reached 12 671 high school students. Items
Table 1. Univariate Analysis: Weighted Percentage of Tanning and Nontanning Students Reporting Substance Usea,b Tanning at Least Once in Past 12 Months, % (No./Total No.)
Characteristic
No Tanning in Past 12 Months, % (No./Total No.)
Odds Ratio (95% CI)
Sex Female
64.5 (551/842)
48.3 (5613/11 302)
Male
33.8 (277/842)
51.1 (5609/11 302)
c
Unknown
2.0 (1.6-2.5)
0.6 (80/11 302)
Age, y ≤12
c
c
13
c
c
14
7.0 (66/837)
17.8 (1993/11 286)
15
19.8 (165/837)
26.2 (3059/11 286)
16
22.2 (200/837)
24.8 (2865/11 286)
17
31.6 (242/837)
23.1 (2471/11 286)
≥18
16.6 (132/837)
7.7 (843/11 286)
a
Unadjusted logistic regression of weighted percentage of students reporting use of each substance in each of the 2 populations (tanning and nontanning). Percent does not equal ratio. Percent is weighted to account for the probability of student selection and to reduce bias by adjusting for differing patterns of nonresponse. Adjustments allow for the generalization of findings to the public high school student population of Colorado.
Any lifetime use Cocaine
23.1 (200/834)
4.0 (500/11 235)
7.2 (5.5-9.3)
Inhalantsd
26.2 (217/836)
5.4 (664/11 221)
6.2 (4.9-7.9)
Heroin
17.7 (161/833)
1.4 (159/11 193)
14.7 (10.6-20.3)
Methamphetamines
18.2 (167/831)
1.8 (216/11 170)
12.0 (8.8-16.3)
b
P < .001 for all characteristics.
Ecstasy
27.8 (234/835)
5.0 (631/11 230)
7.4 (5.8-9.3)
c
Prescription drugse
38.6 (312/837)
11.5 (1400/11 226)
4.9 (3.9-6.0)
Steroidsf
20.8 (177/836)
1.5 (165/11 225)
16.8 (12.2-23.0)
Suppressed owing to raw (unweighted) data being less than 50.
d
Marijuana
66.2 (522/798)
35.3 (4067/11 115)
3.6 (2.9-4.4)
Any one of the above
70.1 (543/780)
39.3 (4464/10 958)
3.6 (3.0-4.5)
Sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high.
e
Prescription drug (such as OxyContin, Percocet, Vicodin, codeine, Adderall, Ritalin, Xanax) used without a prescription.
f
Steroid pills or shots without a prescription.
g
Binge drinking defined as 5 or more drinks of alcohol in a row, within a couple of hours.
Use within last 30 d Marijuana at least once
44.5 (368/802)
18.1 (2180/11 141)
3.6 (3.0-4.4)
Cigarettes at least once
28.5 (258/798)
9.6 (1181/11 179)
3.8 (3.0-4.7)
Alcoholic drink at least once
63.1 (473/745)
29.1 (3312/10 883)
4.2 (3.4-5.1)
Marijuana, alcohol, or cigarette at least once
68.34 (482/698)
35.2 (3946/10 701)
4.0 (3.2-4.9)
Binge drinking at least onceg
40.98 (333/764)
15.3 (1816/10 913)
3.9 (3.1-4.7)
9.6 (101/842)
1.5 (233/11 302)
6.9 (4.9-9.7)
Daily cigarettes
jamadermatology.com
(Reprinted) JAMA Dermatology Published online January 20, 2016
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a McMaster University User on 03/11/2016
E1
Letters
Table 2. Multivariate Analysis: Adjusted Logistic Regression Analysis Stratified by Sexa All, Odds Ratio (95% CI)
P Value
Females, Odds Ratio (95% CI)
P Value
Heroin
2.1 (1.2-3.5)
.01
b
b
Prescription
1.7 (1.3-2.3)
3.7 (1.7-7.8)
